The current meningococcal conjugate vaccine that covers serogroups A, C, W, and Y is recommended for freshmen entering college who will be living in close quarters, such as dormitories. But just how prevalent are these serotypes in adolescents and young adults who have meningococcal disease, and what about serogroup B, for which a vaccine is now available? Mbaeyi et al. (10.1542/peds.2018-2130) decided to look at the epidemiology of meningococcal disease in college-aged students using a national surveillance system for meningococcal disease. From 2014 to 2016, the authors identified 166 cases of meningococcal disease in students aged 18-24 years or 0.17 cases per 100,000 population. They however noted 6 outbreaks of serogroup B on campuses that made up 31.7% of all the serogroup B cases in college students with the risk of serogroup B on campus being significantly higher than in non-college students. In fact, the risk of development serogroup B on campus is much higher than that of serogroups A, C, W, and Y given the role of herd immunity in preventing those serogroups (A, C, W and Y) from infecting college students in close quarters. With the new availability of the Serogroup B meningococcal (MenB) vaccines of which two are licensed in the US, is it time to reconsider recommending that we give MenB vaccine as well to those heading off to college, even though going to college is currently not considered a risk factor for MenB infections mandating we give the vaccine?
We asked Baylor College of Medicine pediatric infectious disease specialists Drs. Lucila Marquez and Sheldon Kaplan to comment on that question and this study in an accompanying commentary (10.1542/peds.2018-3372). They point out the low burden of meningococcal disease in the US as well as our lack of knowledge thus far regarding duration of protection of the MenB vaccine and its effect on carriage. Because MenB continues to be a “category B” recommendation—meaning it is to be considered but not recommended routinely, overall coverage rates from a herd immunity standpoint are low thus far, with only 2% of colleges requiring the vaccine and less than 10% of 16-18-year olds having received this newer vaccine. The good news is that most insurers do cover this vaccine even if a Category B recommendation, and thus Drs. Marquez and Kaplan encourage us to at least educate families about the MenB vaccine with the hope that students and their care providers can then make an informed decision that will hopefully result in greater administration of this vaccine, and in turn an even lower prevalence of this life-threatening organism.
